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Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

  • 编号:
    64A3D82E260121384C321717F2108634
  • 作者:
  • 语种:
    英文
  • 期刊:
    LANCET ISSN:0140-6736 2020 年 395 卷 10229 期 (1054 - 1062) ; MAR 28
  • 收录:
  • 摘要:

    Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described.
    Methods In this retrospective, multicentre cohort study, we included all adult inpatients (>= 18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death.
    Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1.10, 95% CI 1.03-1.17, per year increase; p=0.0043), higher Sequential Organ Failure Assessment (SOFA) score (5.65, 2.61-12.23; p<0.0001), and d-dimer greater than 1 mu g/mL (18.42, 2.64-128.55; p=0.0033) on admission. Median duration of viral shedding was 20.0 days (IQR 17.0-24.0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days.
    Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 mu g/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Copyright (C) 2020 Elsevier Ltd. All rights reserved.

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  • 基金信息:
    Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences [CIFMS 2018-I2M-1-003]; National Science Grant for Distinguished Young Scholars [81425001/H0104]; National Key Research and Development Program of China [2018YFC1200100, 2018YFC1200102]; Beijing Science and Technology Project [Z19110700660000]; Major Projects of National Science and Technology on New Drug Creation and Development [2020ZX09201001]
  • 推荐引用方式
    GB/T 7714:
    Zhou Fei,Yu Ting,Du Ronghui, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study [J].LANCET,2020,395(10229):1054-1062.
  • APA:
    Zhou Fei,Yu Ting,Du Ronghui,Fan Guohui,&Cao Bin.(2020).Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study .LANCET,395(10229):1054-1062.
  • MLA:
    Zhou Fei, et al. "Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study" .LANCET 395,10229(2020):1054-1062.
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